Perceived risks to independent living: the views of older, community-dwelling adults

Characteristics of Occupational Therapy Interventions to Promote Healthy Aging: Protocol for a Scoping Review

BACKGROUND

Healthy aging is a pressing public health priority. Focusing on what people do every day may be a meaningful approach to lifestyle change, suggesting a need for occupation therapy interventions to promote healthy aging. A preliminary database search was conducted, and no current or underway systematic or scoping reviews on the topic were identified. Developing an overview of studies of occupational therapy interventions to promote healthy aging is a necessary first step to understanding the existing knowledge and increasing the impact of future interventions. This scoping review will build on previously conducted reviews.

OBJECTIVE

This scoping review will identify the following: (1) what occupational therapy interventions exist for promoting healthy aging in community-dwelling adults? and (2) what are the intervention characteristics, their evaluated outcome, and the impact observed?

METHODS

This protocol was reviewed by 2 occupational therapists as part of a patient and public involvement consultation. The review will consider all studies and publications of occupational therapy focused on promoting healthy aging in community-dwelling adults who are aged 18 years and older. Databases to be searched are AMED, CINAHL, Cochrane Library, Embase, JBI EBP database, MEDLINE, OAlster, PsycINFO, PsycArticles, ProQuest Dissertations & Theses, ProQuest nursing and allied health source, PubMed, and Science Direct. Studies published in any language will be included. Titles and abstracts will be screened against the inclusion criteria using Covidence (Veritas Health Innovation). Potentially relevant studies will be retrieved in full and assessed against the inclusion criteria. No date limiters will be used. Study selection will be completed by 2 independent reviewers. Data will be extracted using a data extraction tool, including descriptive characteristics of the participants including age, sex, and socioeconomic status. Data will be charted using the TIDieR (Template for Intervention Description and Replication) checklist in alignment with the review objectives. The scoping review will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement.

RESULTS

The research began in October 2023, and the results are expected to be published in 2024.

CONCLUSIONS

This scoping review will produce valuable information about occupation-based interventions to promote healthy aging to support the development of an occupational therapy intervention.

TRIAL REGISTRATION

Open Science Framework 5k36d; https://osf.io/5k36d/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55198.

Posttraumatic Growth as a Process Beginning Before Bereavement: New Perspectives on Theory Development

Calhoun and Tedeschi's growth model focuses on cognitive processing after bereavement but it does not show the change in life narrative from beforehand. Our qualitative study aimed to clarify bereaved family growth and revealed new perspectives on posttraumatic growth (PTG), including that the PTG process involves a pre-bereavement experience and is not limited to positive psychological changes.Based on the two new perspectives, a discussion of PTG theory reveals that bereaved families' PTG can only be accurately captured if the pre-loss experience is included; thus, Calhoun and Tedeschi's growth model, which only captures the post-loss process, is insufficient. Additionally, positive psychological changes are not the only type of growth. When considering growth, one must focus on the process, including the experience of the person realizing that it is "okay to be who they are."

Communication partner perspectives of aphasia self-management and the role of technology: an in-depth qualitative exploration

PURPOSE

"Self-management" empowers individuals to take responsibility for their healthcare through skill-building, personal growth, and self-efficacy related to chronic health condition management. Self-management approaches may benefit people with aphasia (PwA); however, PwA are often excluded from stroke self-management research and there is no published research reporting on aphasia-specific self-management programs. Communication partners (CPs) are involved in the rehabilitation and day-to-day lives of PwA, thus giving them unique insights and knowledge of PwA needs. The present study aimed to investigate CP experiences and perspectives regarding aphasia self-management and to explore CP perceptions of the use of technology in aphasia self-management.

METHODS

In-depth, semi-structured interviews with 14 CPs living in Australia. Interview data was analysed using qualitative content analysis.

RESULTS

Analysis revealed six core themes: (1) aphasia self-management is embedded into everyday life, (2) CPs provide comprehensive self-management support, (3) speech-language pathologists (SLPs) provide tools and support to enable PwA to self-manage, (4) aphasia self-management can be enhanced by technological supports, (5) potential positive outcomes of aphasia self-management, and (6) factors influencing successful aphasia self-management.

CONCLUSIONS

Aphasia self-management programs should focus on individual needs, functional communication in daily life, and social interaction. PwA and CPs are central to these programs, assisted by SLPs. Technology should be explored to augment aphasia self-management.Implications for RehabilitationCommunication partners suggest that people with aphasia are already engaging in aspects of self-management and that more formal aphasia-specific self-management approaches may be beneficial.Dedicated aphasia self-management programs should be situated in daily life with a focus on functional communication, life participation, confidence, and independence.Communication partners, speech-language pathologists, and technology are key support sources for aphasia self-management.Further input should be sought from communication partners in the development of aphasia self-management programs.

Influence of socio-economic profile of neighbourhoods on the selection of home care strategies for older dependants

Care strategies for older dependants are determined by not only individuals or network characteristics, but also contextual factors. The objective of this study is to determine whether urban contexts (neighbourhoods) are linked to the use of family care (informal), public services or private care at home (formal). We applied logistic regression analysis to data from the Survey of People in a Situation of Dependence 2018. The sample was composed of 530 older people (55 years old and over) living in two types of socio-economic groups of neighbourhoods in Barcelona, Spain. The type of neighbourhood is relevant in explaining the home care that older dependants receive. In neighbourhoods with a high socio-economic level, dependants are more likely to use private services and less likely to use informal care services and public services, even after controlling for household income, degree of dependency, sex, age and the number of people in the household. Understanding the factors that determine the use of public care services, private care services or family care-giving is important due to the increment in the number of older people in the population. Our results suggest that differences in urban socio-economic contexts determine some inequalities in the use of services even after controlling for socio-economic individual differences. The characteristics of neighbourhoods should be considered to adjust care policies for older dependants.

I've got to be independent': views of older people on recovery following road traffic injury in New South Wales, Australia

BACKGROUND

Mild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia.

METHODS

A qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ).

RESULTS

Nineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches. Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning.

CONCLUSION

Older people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people's recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision.

TRIAL REGISTRATION

Australia New Zealand clinical trial registry identification number ACTRN12613000889752 .

Innovative Exercise as an Intervention for Older Adults with Knee Osteoarthritis: A Pilot Feasibility Study

L’exercice peut diminuer la morbidité associée à l’arthrose du genou. Nous avons réalisé une étude auprès de 22 participants avec arthrose du genou (68 % de femmes) ayant en moyenne 69,5 ans (ÉT : 7,4). Les participants ont été aléatoirement assignés à un groupe d’exercice de marche carrée (square-stepping exercise; SSE; 2 fois/semaine pour 24 semaines) ou à un groupe contrôle. Nous avons évalué la faisabilité (recrutement et présence) du SSE et son efficacité en lien avec les symptômes (WOMAC), l’équilibre (Fullerton), la mobilité (test de la chaise de 30 secondes) et la vitesse de marche après 12 et 24 semaines. Le groupe SSE avait un taux de présence de 49,3% et sa performance au test de la chaise de 30 secondes tendait à s’améliorer après 12 semaines (F=1,8, p=0,12, ηp2=0,16) et 24 semaines (F=3,4, p=0,09, ηp2=0,18), tout comme sa vitesse de marche à 24 semaines (F=2,4, p=0,14, ηp2=0,14), comparativement au groupe contrôle, en contrôlant pour les données de base. Aucune différence n’a été observée sur le plan des symptômes ou de l’équilibre. Les taux de présence et de recrutement faibles indiquent une faisabilité limitée du SSE chez les personnes âgées avec arthrose du genou. Les tendances observées suggèrent que le SSE peut améliorer la fonction du membre inférieur et la vitesse de marche. Les études futures sur le programme SSE devraient se pencher sur son efficacité en lien avec les symptômes et l’équilibre, et viser l’amélioration de sa faisabilité.

Perception of domestic risks among carers for dependent older persons

BACKGROUND

Despite growing interest for home care, little evidence exists on the perception of domestic risk among carers for dependent older persons. This study aims to characterize the risks to which carers of aging dependent individuals are exposed, and to determine whether these risk dimensions are predictive for effective support, for burden, and for psychological distress.

METHODS

Seventy care partners were questioned about the risk situations identified at the homes of the old people they care for, about the burden they felt in their role, and about their feelings of psychological distress. Securing was evaluated by means of sensibility measures, and overprotection was evaluated by means of specificity measures.

RESULTS

Risk rates were high for loneliness of the old people, wandering, burns, and unsatisfactory health monitoring. There was very little overlap between identification of the risks and implementation of solutions by the caregiver, except for the risks that involved heat. The distinction between accurate securing and overprotection is especially important, because the burden of care partners was linked to uncontrolled domestic risks.

CONCLUSION

Typologies of reactions to risk, characterized by a signal detection approach, could contribute to a better understanding of the situations experienced by care partners, especially situations of neglect and of overprotection.

Valuation of Life Among Old and Very Old Adults: Comparison Between Germany and Japan

Background and Objectives

Valuation of life (VOL) represents a construct capturing individuals’ active attachment to their life. The majority of studies on VOL were conducted in North America and Europe where personal autonomy and independence are highly valued, leaving open the question about the relevance of this construct in interdependence-oriented cultures. Using a framework of cross-cultural and life-span theories, the present study compared levels and predictors of VOL between the young-old and old-old individuals from Germany and Japan.

Research Design and Methods

Two hundred fifty-seven Germans and 248 Japanese, matched by age, gender, education, and IADL, answered a 5-item VOL scale and shared information on sociodemographic, social, and health resources.

Results

Germans’ VOL levels were higher than in Japanese participants. Both culture- and age-moderated predictions of VOL: education was significant only in the young-old Japanese, and close social partners mattered in the old-old, not in the young-old. Health determined VOL irrespective of culture and age.

Discussion and Implications

The findings suggest that cultural values and aging processes should be considered to better understand how individuals value their life and to help older adults to feel that his/her life is meaningful and worth living.

Understanding views on everyday use of personal health information: Insights from community dwelling older adults

BACKGROUND

Older adults apply various strategies to pursue healthy aging, but we know little about their views and use of personal health information to accomplish those ends.

METHODS

As a first step in formulating the role of personal health information management (PHIM) in healthy aging, we explored the perspectives of older adults on health and health information used in their everyday lives through four focus groups with 25 community-dwelling adults aged 60 and over.

RESULTS

We found that the concept of wellness-the holistic and multidimensional nature of health and wellbeing-plays prominently in how older adults think about health and health information. Participants expressed wellness from a position of personal strength, rather than health-related deficits, by focusing on wellness activities for staying healthy through: (1) personal health practices, (2) social network support, and (3) residential community engagement.

CONCLUSION

Although these themes involve personal health information, existing PHIM systems that focus on disease management are generally not designed to support wellness activities. Substantial opportunity exists to fill this wellness support gap with innovative health information technology designed for older adults. Findings carry implications for the design of PHIM tools that support healthy aging and methods for engaging older adults as co-producers of this critical support.

Social Function and Cognitive Status: Results from a US Nationally Representative Survey of Older Adults

BACKGROUND

An early sign of cognitive decline in older adults is often a disruption in social function, but our understanding of this association is limited.

OBJECTIVE

We aimed to determine whether those screening positive for early stages of cognitive impairment have differences across multiple dimensions of social function and whether associations differ by gender.

DESIGN

United States nationally representative cohort (2010), the National Social life, Health, and Aging Project (NSHAP).

PARTICIPANTS

Community-dwelling adults aged 62-90 years (N = 3,310) with a response rate of 76.9 %.

MAIN MEASURES

Cognition was measured using a survey adaptation of the Montreal Cognitive Assessment categorized into three groups: normal, mild cognitive impairment (MCI), and dementia. We measured three domains of social relationships, each comprised of two scales: network structure (size and density), social resources (social support and social strain), and social engagement (community involvement and socializing). We used multiple linear regression to characterize the relationship of each social relationship measure to cognition.

KEY RESULTS

Individuals screened as at risk for MCI and early dementia had smaller network sizes by 0.3 and 0.6 individuals (p < 0.001), and a 10 % and 25 % increase in network density (p < 0.001), respectively. For social resources, individuals at risk for MCI and dementia had 4 % and 14 % less social strain (p = 0.01), but only women had 3 % and 6 % less perceived social support (p = 0.013), respectively. For social engagement, individuals screened positive for MCI and dementia had 8 % and 19 % less community involvement (p = 0.01), but only men had 8 % and 13 % increased social involvement with neighbors and family members (p < 0.001), respectively.

CONCLUSION

Changes in social functioning provide an early indication to screen for cognitive loss. Recognition that early cognitive loss is associated with differences in social function can guide counseling efforts and help identify social vulnerabilities to ease the transition to overt dementia for both patients and caregivers.

Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort

BACKGROUND

Recent studies have demonstrated the superiority of endovascular therapy (EVT) for emergent large vessel occlusion.

OBJECTIVE

To determine the effectiveness of EVT in nonagenarians, for whom data are limited.

METHODS

We retrospectively reviewed clinical and imaging data of all patients who underwent EVT at two stroke centers between January 2012 and August 2014. The 90-day functional outcome (modified Rankin Scale (mRS) score) was compared between younger patients (age 18-89 years; n=175) and nonagenarians (n=18). The relationship between pre-stroke and 90-day post-stroke mRS was analyzed in these two groups. Multivariable analysis of age, recanalization grade, and admission National Institutes of Health Stroke Scale (NIHSS) for predicting outcome was performed.

RESULTS

Age ≥90 years was associated with a poor (mRS >2) 90-day outcome relative to those under 90 (89% vs 52%, OR=8, 95% CI 1.7 to 35.0; p=0.0081). Nonagenarians had a higher pre-stroke mRS score (0.77; 95% CI 0.44 to 1.30) than younger patients (0.24; 95% CI 0.17 to 0.35; p=0.005). No difference was observed between nonagenarians and younger patients in the rate of mRS change from pre-stroke to 90 days (p=0.540). On multivariable regression, age (OR=1.05, 95% CI 1.03 to 1.08; p<0.0001), recanalization grade (OR=0.62 95% CI 0.42 to 0.91; p=0.015), and admission NIHSS (OR=1.07 95% CI 1.02 to 1.13; p=0.01) were associated with a poor 90-day outcome.

CONCLUSIONS

Nonagenarians are at a substantially higher risk of a poor 90-day outcome after EVT than younger patients. However, a small subset of nonagenarians may benefit from EVT, particularly if they have a good pre-stroke functional status. Further research is needed to identify factors associated with favorable outcome in this age cohort.

Racial Differences in the Effects of Neighborhood Disadvantage on Residential Mobility in Later Life

OBJECTIVES

Past research on the residential mobility of older adults has focused on individual-level factors and life course events. Less attention has been paid to the role of the residential environment in explaining residential mobility in older adults. We sought to understand whether neighborhood disadvantage had predictive utility in explaining residential relocation patterns, and whether associations differed between Whites and non-Whites.

METHOD

Data are from the National Social Life, Health and Aging Project, a nationally representative sample of community-dwelling older adults. Neighborhoods were defined at the census tract level. Local movers (different census tract, same county) and distant movers (different county) were compared with stayers.

RESULTS

After adjusting for individual-level factors, neighborhood disadvantage increased the likelihood of a local move, regardless of race/ethnicity. For non-Whites, higher neighborhood disadvantage decreased the likelihood of a distant move. Among local movers, Blacks and Latinos were less likely to improve neighborhood quality than Whites.

DISCUSSION

Neighborhood disadvantage may promote local mobility by undermining person-environment fit. Racial differences in access to better neighborhoods persist in later life. Future research should explore how older adults optimize person-environment fit in the face of neighborhood disadvantage when the possibility of relocation to a better neighborhood may be restricted.

Risky decision-making is associated with residential choice in healthy older adults

As our society becomes more mobile and people reside farther away from their immediate families, competent decision-making has become critical for the older adults wishing to maintain their independence. However, very little is known about the relationship between residential choice and decision-making. Here we use the Balloon Analog Risk Task (BART) to examine risk-taking in two samples of older adults, one living in a retirement community and another living independently. We also used a cognitive model to gain insight into the cognitive factors underlying decision-making in these groups. We found that older adults living in a retirement community were more risk averse than their independent counterparts. Furthermore, this difference appeared to be motivated by group differences in initial perception of risk. This study suggests an intriguing difference between these two residential groups, and also points to the utility of using laboratory methods in research on real-world problems.

Work Postures When Assisting People at the Toilet

The aim of our study was to analyze home care workers’ movement patterns and back postures, relating them to risks while helping an ambulatory care recipient to and from the toilet in a homelike environment. We found that severe risks of unpredictable movements with exposed postures could explain many injuries. Because of high-risk injuries, we suggest decreasing the time when the care recipient stands and the home care worker helps with clothing and personal hygiene. We also suggest the development of support in front of the recipient to prevent her or him from falling forward.

Older adults' meanings of preparedness: a New Zealand perspective

Contemporary Western social policy encourages older adults to maintain independence in the community. Socio-cultural norms of independence have recently become associated with successful ageing. Personal autonomy and self-responsibility are cultural markers by which older adults increasingly define their lives and identity. Many older adults seek to remain independent within their communities, while coping with age-related decline, and living alone with decreased social connectedness. These characteristics have also been associated with personal and social vulnerability and explain why older adults are at higher risk of experiencing disproportionate negative outcomes during disasters. This paper describes findings from narrative interviews with a sample of independent community-dwelling New Zealand older adults. The interviews sought to explore their views about disaster preparedness. However, within their accounts was a collective and bigger story about personal preparedness, and social relationships in later life, which extended beyond the context of preparing for a future disaster event. Older adults identified age-specific preparedness as a way to maintain independence in the everyday context of their lives. Concerns about health influenced their choices and actions as they evaluated and prioritised goals and strategies to maintain independence and wellbeing. Social relationships were also considered an important resource to support independence. Understanding the role of preparedness in the everyday lives of older adults has implications for improving the disproportionate negative outcomes this vulnerable age group can experience during a disaster. Therefore, health, gerontology and emergency management have much in common when considering older adults' preparedness during non-disaster times.

‘At home it's just so much easier to be yourself’: older adults' perceptions of ageing in place

By 2050, the number of people in Australia aged over 85 is expected to quadruple. Yet, from a socio-psychological research perspective, little is known about the experiences of people who continue to live at home during late old age (85 years and over), a period when challenging problems associated with ageing escalate and threaten to compromise independence. Utilising a qualitative methodology, the subjective lived experience of 23 very old adults (19 women, four men, with a mean age of 90.7 years, range 85–101 years) who live independently in rural Australia were elicited. The aims of the research were to understand their thoughts and feelings about ageing in place at home, and what psychological, social and practical adaptive strategies they employ to cope with difficulties encountered during very old age. In-depth interviews were analysed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases and interpretation of exemplars. Participants described how historical, cultural and environmental contexts shaped their everyday thoughts, activities and what was meaningful for them. The findings add to our understanding of the largely unnarrated lives of the very old, suggest a need for person-centred home-care assessment processes and aid significant others (family, friends and neighbours) to understand better what very old adults need to live independently.

Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.

The meaning of "independence" for older people in different residential settings

OBJECTIVES

Drawing on older people's understandings of "independence" and Collopy's work on autonomy, the article elaborates an interpretive framework of the concept in relation to 3 residential settings-the private dwelling-home, the extra-care, and the residential-care settings.

METHOD

Data include 91 qualitative interviews with frail, older people living in each setting, collected as part of a larger Welsh study. Thematic analysis techniques were employed to identify patterns in meanings of independence across settings and then interpreted using Collopy's conceptualizations of autonomy, as well as notions of space and interdependencies.

RESULTS

Independence has multiple meanings for older people, but certain meanings are common to all settings: Accepting help at hand; doing things alone; having family, friends, and money as resources; and preserving physical and mental capacities. Concepts of delegated, executional, authentic, decisional, and consumer autonomy, as well as social interdependencies and spatial and social independence, do provide appropriate higher order interpretive constructs of these meanings across settings.

DISCUSSION

A broader interpretive framework of "independence" should encompass concepts of relative independence, autonomy(ies), as well as spatial and social independence, and can provide more nuanced interpretations of structured dependency and institutionalization theories when applied to different residential settings.

A walker used as a lifting device

PURPOSE

To develop assistive technology that would help an older person to arise from a kneeling position to a standing one.

METHODS

Developing a prototype, based on an inclusive design and then testing the prototype to verify the approach. The prototype was subsequently tested by a panel of 20 elderly users. These tests were observed and filmed. Participants' experiences of being lifted with the elevation seat were registered with the VIDAR ergonomic assessment system.

RESULT

None of the 20 participants used a walker at that time. In response to a question of whether, assuming they might have to use a walker in the future, they thought that a walker with an elevating seat would be helpful, 18 said that it would. Two of the participants did not believe that they would ever have to use a walker.

CONCLUSION

A simple assistive technology such as a walker equipped with an elevating seat would in many of these cases simplify matters and reduce the distress of people who fall often. In addition, such a device can allow people who fall often to live in their homes longer. For caregivers dealing frequently with people who fall, this assistive device can contribute to decreasing occupational injuries.

IMPLICATIONS FOR REHABILITATION

Development of a lifting device that can help people raise themselves up entirely on their own, or with minimal assistance, would be a revolutionary step for the individual. Lifting devices in use today requires much more extensive assistance from home helpers or others and due to the risk of injuries it is a great value for the helpers that easy to use devices develops. A walker equipped with an elevating seat could even provide a potential for people to stay in their homes longer.

“You Don’t Want to Ask for the Help” The Imperative of Independence

Independence is highly valued in Western society. The emphasis on independence and consequent fear of dependence may, however, have a downside, potentially leading to social exclusion. Through photovoice methodology, we explored what older adults say about the importance of independence in their lives and how independence may relate to social exclusion. Data consisted of photographs, journals, interviews, and focus group transcripts from 30 participants residing in Manitoba, Canada, collected as part of a larger program of research on “age-friendly” communities. Findings highlighted the importance of resources and supports to help older adults remain independent and feel included and that fear of dependence and being perceived as “old” can lead to social exclusion. Policy initiatives designed to make communities more age-friendly are one way to enhance older adults’ independence and, ultimately, quality of life. It is equally important, however, that such initiatives go hand-in-hand with reimaging aging and old age.

Responding to home maintenance challenge scenarios: the role of selection, optimization, and compensation in aging-in-place

This study examined potential issues faced by older adults in managing their homes and their proposed solutions for overcoming hypothetical difficulties. Forty-four diverse, independently living older adults (66-85) participated in structured group interviews in which they discussed potential solutions to manage difficulties presented in four scenarios: perceptual, mobility, physical, and cognitive difficulties. The proposed solutions were classified using the Selection, Optimization, and Compensation (SOC) model. Participants indicated they would continue performing most tasks and reported a range of strategies to manage home maintenance challenges. Most participants reported that they would manage home maintenance challenges using compensation; the most frequently mentioned compensation strategy was using tools and technologies. There were also differences across the scenarios: Optimization was discussed most frequently with perceptual and cognitive difficulty scenarios. These results provide insights into supporting older adults' potential needs for aging-in-place and provide evidence of the value of the SOC model in applied research.

Diabetes Among Recipients of Home Health Services in the United States

The 2007 National Home and Hospice Care Survey was used to generate representative data on diabetic home health patients in the United States. Approximately 30% of home health patients have diabetes (11% have diabetes as the primary diagnosis), 28% were <65, 62% were women, and diabetic patients were more likely to be non-White. Nearly 75% received services immediately following a hospital or emergency room stay, 32% lived alone and nearly 20% did not have a primary caregiver. More than 40% of these patients needed assistance with ≥4 activities of daily living, 38% needed assistance with medication management and more than two thirds of families of diabetic patients received services from the agency that was serving the patient. The cost of services for home health patients with a primary diagnosis of diabetes is US$17.9 million/day.

Chronic Illness Self-Management While Living Alone in Later Life

Older people living alone (OPLA) are considered vulnerable because of fewer resources, such as social support. As self-management becomes increasingly important in chronic care, evidence is needed on how to better support OPLA. This review synthesizes the evidence from 32 publications on the challenges as well as strategies of OPLA in managing chronic conditions. On the basis of a systematic database search and review process, being independent and being at home were identified as crucial when living alone in later life; both involve decision making and the adjustment of routines to manage everyday life and chronic conditions. These findings show that OPLA are vulnerable because of difficult living situations, limited resources, or a lack of support, and they actively manage their conditions using various strategies to remain independent, but these may cause fragile arrangements that can jeopardize independence. Awareness of these strategies is a starting point to develop interventions for self-management support in chronic illness.

Living arrangement concordance and its association with self-rated health among institutionalized and community-residing older adults in China

Although many studies look at the relationship between living arrangement and health among older adults, very little research takes seniors' preferred living arrangements into account. This paper uses data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) to examine what factors are associated with concordance between actual and preferred living arrangements for both institutionalized and community-residing Chinese seniors, and to investigate associations between living arrangement concordance and self-rated health. Our analyses show that economic independence is negatively associated with living arrangement concordance among institutionalized older adults (net of other factors), while being older, female, minority ethnicity, having higher SES, and being unmarried are positively associated with living arrangement concordance among community-residing seniors. For both institutionalized and community-residing older adults, living arrangement concordance increases the likelihood of rating self-rated health as good, with concordance having a greater impact on health for institutionalized elders (odds-ratios of 1.67-1.93) than for community-residing elders (odds-ratios of 1.12).

The myth of independence for older Americans living alone in the Bay Area of San Francisco: a critical reflection

Remaining at home in older age is generally considered a sign of independence and therefore an important achievement. More than five million Americans aged over 75 years live alone, a number that is destined to increase thanks to advances in longevity. Living alone can allow the expression of one's preferences, but it can also bring out hardships hardly visible to outsiders, especially in an individualistic society such as the United States of America that rewards self-sufficiency. According to the sociologist Rose, in neo-liberal societies citizens have a duty to be free, self-reliant and independent. In this paper, Rose's theory and the political economy perspective serve as frameworks by which to examine how discourses around independence are translated in the experiences of 22 older adults aged over 75 living at home alone in the Bay Area of San Francisco. Participant observation and 41 in-depth interviews from 2006 to 2010 illustrate how being independent can be an essential component of individual identities. The informants' narratives shed light on the impact of policies that facilitate or regulate the moral imperative of independence. The findings underline the need to assess how discourses around independence are translated in minority populations, to promote studies and initiatives on interdependence, and to encourage international comparisons on living alone in older age.

Wellbeing, independence and mobility: an introduction

This paper introduces the theme of the special issue on wellbeing, independence and mobility. We begin with outlining the complexity of each of these notions and then turn towards their interdependence. It is argued that the links between wellbeing, independence and mobility are manifold and contextual in older people's everyday lives: they differ between places, between individuals and across phases in each individual's unique lifecourse. The inherent complexity of those links can be examined fruitfully and understood better if a geographical or environmental analytical perspective is adopted. We also suggest that the interdependence of wellbeing, independence and mobility in later life needs to be understood in the context of neo-liberal governmentality and the creation of particular ways of being and acting for older people. The piece concludes with a brief description of the papers brought together in the special issue.

Regression-based estimates of observed functional status in centenarians

PURPOSE OF THE STUDY

There is lack of consensus on the best method of functional assessment, and there is a paucity of studies on daily functioning in centenarians. We sought to compare associations between performance-based, self-report, and proxy report of functional status in centenarians. We expected the strongest relationships between proxy reports and observed performance of basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). We hypothesized that the discrepancy between self-report and observed daily functioning would be modified by cognitive status. We additionally sought to provide clinicians with estimates of centenarians' observed daily functioning based on their mental status in combination with subjective measures of activities of daily living (ADLs).

DESIGN AND METHODS

Two hundred and forty-four centenarians from the Georgia Centenarian Study were included in this cross-sectional population-based study. Measures included the Direct Assessment of Functional Status, self-report and proxy report of functional status, and the Mini-Mental State Examination (MMSE).

RESULTS

Associations between observed and proxy reports were stronger than between observed and self-report across BADL and IADL measures. A significant MMSE by type of report interaction was found, indicating that lower MMSE performance is associated with a greater discrepancy between subjective and objective ADL measures.

IMPLICATIONS

Results demonstrate associations between 3 methods of assessing functional status and suggest proxy reports are generally more accurate than self-report measures. Cognitive status accounted for some of the discrepancy between observed and self-reports, and we provide clinicians with tables to estimate centenarians' performance on observed functional measures based on MMSE and subjective report of functional status.

Marginal Competence, Risk Assessment, and Care Decisions: A Comparison of Values of Health Care Professionals and Older Adults

Par l’utilisation d’un scénario impliquant une femme âgée vivant seule compétent marginalement à risque, nous avons évalué les decisions liées aux soins réalisés par les adultes plus âgés (n = 82) et les professionnels de la santé (professionnels de la santé, n = 87), et les différences identifiées dans les valeurs qui sous-tendent les décisions relatives aux soins. Dans l’ensemble, les participants n’ont pas placé une grande valeur à l’independance quand on a évalué les risques pour le client comme plus élevé et la sécurité comme aussi bas. Dans ces conditions, les répondants âgés tendaient à être plus paternaliste dans leurs décisions concernant les soins, tandis que les professionnels de la sante ont tendance à être plus salutaire. Si les valeurs des professionnels de la santé diffèrent de ceux des personnes âgées, quelle est la probabilité que les soins dispensés aux personnes âgées peu compétentes seront conformes à leurs désirs? Les soins donnés par les professionnels de la santé pourrait être ameliorés en y incorporant la connaissance des valeurs et des perspectives des autres adultes âgés.

Involving the Community Elderly in the Planning and Provision of Health Services: Predictors of Volunteerism and Leadership

A rapidly growing older population has led to changes in health care, including a community health movement with an emphasis on community collaboration, self-help, and capacity building. This study examined factors in the lives of older individuals that influenced their ability and willingness to participate in a health-related community-capacity-building project to help their frailer, older neighbours. Using cross-sectional survey methodology, 107 volunteers who lived in a high density seniors' apartment complex known for its high health service utilization were compared with a random sample of 74 non-volunteers from the same community. Factors associated with volunteer involvement included age, activity level, functional ability, life satisfaction and certain personality characteristics. The study suggests that, within a community, the “younger-old” may be able to support their frailer, older neighbours so that they can remain living in the community.

Medical and Everyday Assistive Device Use among Older Adults with Arthritis

This research compared older adults' use of medical assistive devices (ADs) with their use of everyday ADs as a means of managing chronic physical disability. The study also examined whether predisposing, need, and enabling factors were associated with device use in three domains of activity: personal care / in-home mobility, household activities, and community mobility. Participants were 248 adults, aged 55 years and older, with a wide range of disability levels as a result of osteoarthritis. All participants were administered an in-depth, structured questionnaire, as part of a larger study examining older adults' independence and adaptation to chronic physical illness. The results revealed that respondents actively adapted to their disabilities and used a wide range of medical and everyday devices, with everyday devices being reported more than twice as often as medical ADs and the fewest devices overall being reported for community mobility. In general, medical devices were used when subjective and objective need for ADs was considerable. Everyday devices were reported earlier in the trajectory of the disease, at mild and moderate disability levels, and were associated with a broader pattern of adaptation that included planning to avoid problems, exercise, and pacing activities.

Older women, breast cancer, and social support

Introduction

One in ten women over the age of 65 will develop breast cancer. Despite this high incidence of breast cancer among older women, social support for them is often inadequate. This paper describes a qualitative study of the impact of a breast cancer diagnosis on older women from racially/ethnically diverse populations and their subsequent need for social support.

Methods

Forty-seven older African American, Asian American, Caucasian and Latina women between the ages of 65 to 83 participated in a larger study examining the impact of breast cancer on women from racially/ethnically diverse populations and the meaning and nature of social support. The women completed an in-depth qualitative interview on the psychosocial impact of breast cancer and the meaning and nature of social support.

Results and Conclusion

The results indicate that there are variations in reactions to a breast cancer diagnosis among older women, and that these reactions impact their experiences with seeking social support at diagnosis and during treatment. Respondents were concerned about their aging bodies, potential dependency on others, and loss of autonomy. At the same time, the severity of cancer treatment and existing co-morbidities often meant they needed to learn to receive support, and to reach out if they had no support. The implications of these findings underscore the older cancer patient’s need to strengthen her supportive networks at the time of diagnosis, during treatment, and post-treatment.

Sooner or later? A study of institutionalization in late life

BACKGROUND AND AIMS

Existing information about institutionalization of elderly individuals is mainly based on cross-sectional data and does not address the cumulative risk of institutionalization. The purpose of the present study was to analyze longitudinal data prospectively and estimate the risk of placement in an elder care institution for individuals aged 70 years or older.

METHODS

The study was based on a longitudinal investigation (the H70 study) of a random sample of 70- year-olds living in Gothenburg, Sweden, in 1971. Individuals were followed from age 70-100 years. Three different analyses were performed: a descriptive prospective analysis, cross-sectional analyses at ages 70, 79 and 85 years, and a longitudinal analysis of predictors for institutionalization.

RESULTS

The prospective analysis indicated that 50% of the individuals eventually moved to an elder care institution. Significantly more women than men were institutionalized, although for women the move occurred later in life. Cross-sectional analyses demonstrated that various factors were important to institutionalization at different ages. The Cox regression model with time-varying covariates indicated that gender, socio-economic situation, marital status, number of symptoms, having children living nearby, and activities in daily life were related to institutionalization.

CONCLUSIONS

The proportion of elderly persons relocating to institutions was significantly higher than that generally found in cross-sectional studies. It was possible to identify variables that predict institutionalization during a subsequent 30-year period, but different analyses revealed different effects from the factors evaluated.

Activity limitation, coping efficacy and self-perceived physical independence in people with disability

OBJECTIVE

This study examines whether the relationships between activity limitations and independence are mediated by coping efficacy.

METHOD

Data come from a cross-sectional survey of 286 adults, aged 55 or older, with osteoarthritis (OA) and/or osteoporosis (OP). Physical independence was assessed by asking to what extent respondents' OA/OP had affected their independence on a 5-point scale from 'not at all' to 'a great deal'. Activity limitations were examined in three domains: personal care, community mobility, and household activity. A coping efficacy scale was derived from three items scored on a 5-point Likert-type scale from strongly disagree to strongly agree. Structural equation modelling was used to test the model.

RESULTS

Activity limitation in household activities was directly associated with perceptions of independence, with a statistically significant standardized path coefficients of -0.32. The effect of activity limitation in personal care was partially mediated by coping efficacy with a direct effect of -0.41 which was partially offset by coping efficacy to give a net effect of -0.308. The effect of community mobility on independence was completely mediated through coping efficacy with significant standardized path coefficients of -0.85 (community mobility to coping efficacy) and -0.14 (coping efficacy to independence). The overall model's goodness of fit was excellent (R =0.59, ch-square/df=1.4, CFI=0.97, and NNFI=0.97).

CONCLUSION

Activity limitation had a detrimental effect on the level of self-perceived independence. Coping efficacy showed a significant mediating effect between activity limitation and self-perceived independence for the domains of personal care and community mobility, but not household tasks. This study suggests that how activity limitation affects perceptions of independence varies across activity limitation domains, and indicates the importance of incorporating activity limitation domains in future studies.

Motives for residential mobility in later life: post-move perspectives of elders and family members

This qualitative study delineates motives for residential mobility, describes dynamics between the elder and family members during the move decision process, and locates the move decision within ecological layers of the aging context. Interviews were conducted with 30 individuals and couples (ages 60-87) who experienced a community-based move within the past year, and with 14 extended family members. Reasons for moving (from perspectives of both elders who moved and their family members) were grouped into four themes and eleven issues that influenced the move decision. These themes parallel the ecological context of individual health and functioning, beliefs and attitudes, physical environment, and social pressures. Late-life mobility is a significant life transition that is the outcome of an ongoing appraisal and reappraisal of housing fit with individual functioning, needs, and aspirations. Family members are an integral part of these decision and residential mobility processes.

Daily eating events among co-living and single-living, diseased older men

OBJECTIVES

To analyse, describe and compare the frequency and energy intake of eating events, including specific food items, among diseased older men living in ordinary housing.

DESIGN

Descriptive and explorative.

SETTING

Interviews were performed in the participants' home.

PARTICIPANTS

Thirty-five co-living and 26 single-living men, 64-88 years of age. Participants had one of three chronic diseases associated with difficulties in buying and preparing food and with difficulties related to the meal situation: Parkinson's disease, rheumatoid arthritis or stroke.

MEASUREMENTS

A repeated 24-h recall was used to assess food intake and meal patterns.

RESULTS

Eating events were distributed over a 24-h period. Co-living men had a higher (p=0.001) number of eating events/day; both hot and cold eating events were consumed more frequently. There was no difference between groups concerning energy intake. Co-living men more often had hot eating events cooked from raw ingredients (p=0.001) and a greater mix of vegetables/roots (p=0.003) included in such eating events.

CONCLUSION

Single-living men may constitute a vulnerable group from a nutritional perspective, while co-living men, besides the pleasure of eating with another person, seem to get support with food and eating events from their partners. Hence, the group of single-living men, particularly those with a disability, should receive particular attention with regard to possible food-related difficulties.

Experiences of women with osteoarthritis in assisted living facilities

PURPOSE

Osteoarthritis is one of the most common causes of disability in older adults. To help patients self-manage their arthritis, nurses need a better understanding of experiences of living with arthritis. Many older adults with symptomatic osteoarthritis may reside in supportive housing such as assisted living facilities. Recognizing challenges and symptoms may lead to improved health and quality of life, as well as greater independence, for older adults with osteoarthritis.

METHODS

A naturalistic inquiry design was used to gather data from 23 older women. Transcriptions were analyzed by deconstruction and reconstruction.

RESULTS

Final themes are Restricting and Constricting, with intermediate categories of Not doing because of disability, Not doing by choice, Limiting ability to move without assistive devices, and Living within confining spaces.

CONCLUSIONS/IMPLICATIONS

Findings suggest the need for further examination of symptoms, symptom management, and interventions to improve healthcare and quality of life of patients with osteoarthritis.

The lived experience of oldest-old rural adults

The author elicited the lived experience of 19 oldest-old adults (13 women, all White, mean age 90.7 years, range 85-98 years) who lived alone in the rural Midwest to describe their everyday activities, concerns and struggles, and adaptive strategies. In-depth interviews (59 total) were audiotaped, transcribed, and analyzed in an interpretive phenomenological tradition of thematic analysis, interpretation of paradigm cases, and interpretation of exemplars. Participants described how historical, cultural, and environmental contexts shaped their everyday thoughts, activities, and what was meaningful to them. Findings can guide health care professionals to evaluate and develop community services and help significant others (family, friends, neighbors) understand what oldest-old rural adults need to remain at home.

Driving and dementia in Ontario: a quantitative assessment of the problem

BACKGROUND

The population is becoming increasingly aged, and concomitantly, the prevalence of dementia is steadily rising. Persons aged 65 years and over are likely to continue driving for many years and often well into the dementia process.

METHODS

Ontario Ministry of Transportation driving data, census data, and dementia prevalence data were combined to determine the number of persons with potential dementia who are driving, both now and in about 25 years' time.

RESULTS

Actual and projected Ontario figures show that the number of senior drivers will increase markedly from just under 500,000 in 1986 to nearly 2,500,000 in 2028. Similarly, the number of drivers with dementia is also increasing. Although not all drivers with dementia are necessarily dangerous, most are estimated to continue driving well into the disease process. By combining the above-mentioned data sets, a best estimate of the number of drivers with dementia in Ontario was derived. It is estimated that this group has grown from just under 15,000 in 1986 to about 34,000 in 2000 and will number nearly 100,000 in 2028.

INTERPRETATION

Increasingly, the responsibility for identifying drivers with dementia has fallen on the health care system, a role for which it was never designed nor equipped to handle. The risks associated with the dramatically increasing number of drivers with dementia demand a psychometrically sensitive and efficient screening procedure.

Aging Happens: Experiences of Swiss Women Living Alone

The purpose of this study was to give beginning insights into how aging is experienced by women living alone in Switzerland. A feminist methodology was used to gather and interpret 17 interviews conducted with a selected group of 9 older women living alone. Interviews were taped and transcribed for hermeneutic analysis; major themes were developed. Aging happens, Independence, Being vulnerable, Memory and aging, and If I had been a boy were the themes discovered. These experiences represent how aging is shaped by individual life courses, sociocultural conditions along with gender and class.

Older women's perceptions of independence versus dependence in food-related work

This qualitative study aims to explore the cultural meaning of accomplishing food-related work by older women, when disease has diminished their abilities and threatens to make them dependent. Seventy-two women with stroke, rheumatoid arthritis, and Parkinson's disease, as well as women without those diseases, were interviewed. All were living at home. Results showed that older women valued independence and feared dependence when declining ability threatened performance of food-related work. They also had strong beliefs about living a "normal life," managing by oneself as long as possible, and becoming their own masters again. To remain independent, participants used three kinds of strategies: Public Health Service Support, self-managing, and adaptation. Their beliefs about dependence included not becoming a burden, retaining self-determination, and maintaining order in life. Implications for nursing include supporting independent cooking, developing care plans with the care recipient, and demonstrating respect for the women's self-determination.

Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter (SIMA)

Zusammenfassung: Im Rahmen der 1991 begonnenen Längsschnittstudie SIMA wurde die Entwicklung der Selbstständigkeit der Teilnehmer zwischen 1991 und 1998 verfolgt. Für insgesamt 340 der ursprünglich 375 Teilnehmer ließ sich bis Ende 1998 der Status im Hinblick auf Unselbstständigkeit, Demenz und Mortalität ermitteln. Die Teilnehmer lebten bei Studienbeginn selbstständig und waren zwischen 75 und 93 Jahren bzw. im Mittel 79,5 ± 3,5 Jahre alt. In multivariaten Risikoanalysen (Cox Regression) wurden signifikante medizinische und psychologische Risikofaktoren bestätigt. Als hoch signifikante Unselbstständigkeitsrisiken erwiesen sich Apoplex, Depression, eine submediane subjektive Bewertung der Befindlichkeit sowie spezifische Gedächtnisdefizite. Als bedeutendste Demenzrisiken ließen sich verschiedene kognitive Leistungsdefizite und das Vorliegen einer Frühsymptomatik identifizieren. Die höchsten Zusammenhänge mit der Mortalität wiesen Rauchen, Diabetes mellitus sowie jeweils eine subjektive Bewertung der Gesundheit und eine körperliche Leistungsfähigkeit unter dem Gruppenmedian auf. Die Befunde der SIMA-Studie zeigen, dass weder eine hohe Multimorbidität noch einzelne typische Erkrankungen die ausschließlichen Unselbstständigkeits-, Demenz- oder Mortalitätsrisiken im höheren Lebensalter darstellen. Die gleichzeitige Bedeutung psychologischer Risikofaktoren, z. B. von Einschränkungen in der Befindlichkeit oder Defiziten in visuellen Gedächtnisleistungen bzw. der kognitiven Geschwindigkeit, sowie eines Mangels an körperlichen Aktivitäten dokumentiert zudem, dass einer Unselbstständigkeit und möglicherweise auch einer Demenz durch ein multimodales Trainingsprogramm erfolgreich begegnet werden kann.